Pre-Hospital Outcomes for Evidence-Based Evaluation (PHOEBE)

National Institute for Health Research – Programme Grant for Applied Health Research

Total funding

£2,035,959

Team

Professor Niroshan Siriwardena, Associate Clinical Director / Professor of Primary and Pre-hospital Health Care, East Midlands Ambulance Service & Community and Health Research Unit, School of Health & Social Care, University of Lincoln

Ms Janette Turner, Research Fellow, School of Health & Related Research (ScHARR)

Professor Jonathan Nicholl, Director, Medical Care Research Unit (MCRU), School of Health & Related Research (ScHARR), University of Sheffield

Professor Steve Goodacre, Professor of Emergency Medicine, School of Health & Related Research (ScHARR), University of Sheffield

Professor Ronan Lyons, Professor of Health Services Research, School of Medicine, Swansea University

Mr Andrew Booth, Reader in Evidence-Based Information Practice and Director of Information, School of Health & Related Research (ScHARR), University of Sheffield

Professor Helen Snooks, Professor of Health Services Research, School of Medicine, Swansea University

Professor John Brazier, Professor of Health Economics, School of Health & Related Research (ScHARR), University of Sheffield

To develop new ways of measuring process and outcome indicators including building the adjustment models that predict the outcomes using the linked data

To explore the practical use of the linked dataset and the risk adjustment models to measure the effectiveness and quality of ambulance service care and assess how they can be best used to support quality improvement strategies.

Methods

Synthesis of evidence on outcome measures and identification of measures for further development – review and assessment of the evidence base on outcome measurement for pre-hospital care and a consensus study to identify measures relevant to patients and NHS staff

Development of risk adjustment models for outcomes in patients attended by the ambulance service – using the linked data to develop risk adjustment tools that will allow patient differences to be taken into account and differences between expected and actual outcomes to be detected

Testing the risk adjustment models to assess if they can be used to measure effectiveness and quality – exploring the practical application of the measures by using them to assess if different ways of quality – exploring the practical application of the measures by using them to assess if different ways of providing ambulance service care result in different consequences for patients, and assessing the views of potential users about how they can best be implemented in the NHS.

Outcomes

Develop a method for linking healthcare information into a format that can be used to support quality improvement, is acceptable to patients and complies with information legislation. Develop population-based models for measuring the impact of pre-hospital care that can be used to monitor quality and safety, evaluate new service innovations and support quality improvement. Provide added value by using routine information and NHS infrastructure to operationalise the process and outcome models so they will be of use across the NHS.

Coster J. How should we measure ambulance service quality and performance? Results from a Delphi study. 8th European Congress on Emergency Medicine, 28 September -1 October 2014, Westergasfabriek BV, Amsterdam 8th European Congress on Emergency Medicine, 28 September -1 October 2014, Westergasfabriek BV, Amsterdam. Top scoring abstract: How should we measure ambulance service quality and performance? This was a high scoring abstract (ranked in the top 3 out of 1000) and was presented at the EuSEM 2014 Awards Ceremony and at the Prehospital Emergency Medicine Lightning Session at the European Society of Emergency Medicine (EuSEM).

Turner J,Irving A,Wilson R, Siriwardena AN,Phung VH. How should we measure ambulance service quality and performance? International Conference on Emergency Medicine, 11-14 June 2014, Hong Kong Convention and Exhibition Centre.

This project will change the way in which the quality of ambulance services is measured. It will enable ambulance services to go beyond just measuring performance in terms of response times. This will impact on the operation of ambulance services from organisations that concentrate on meeting response time targets to those that are geared to improving quality of care and patient outcomes.

The Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) programme has led to the development of new quality measures for ambulance services. The findings have already informed the UK Ambulance Response Programme and shaped the new ambulance standards introduced in 2017.

The findings have been shared through the National Ambulance Research Steering Group (NARSG), the National Ambulance Services Clinical Quality Group (NASCQG), the National Ambulance Services Medical Director’s group (NaSMed) and the Association of Ambulance Chief Executives (AACE).

The findings were shared by Professor Siriwardena with US Emergency Medical Services physicians in an invited lecture at the North American EMS Physicians conference in San Diego, Ca, in January 2018 and are already influencing the development of ambulance indicators in the US and Canada.

The findings for the programme have been summarised in an animation video produced by Vivid Creative 2017.